HOPE in Action: A Multicenter Prospective Study of HIV to HIV Liver Transplantation

C. Durand¹, S. Florman², M. Bowring³, D. Brown¹, B. Haydel², J. Hamilton¹, P. Stock⁴, J. Price⁵, T. Pruett⁶, V. Kirchner⁷, D. Wojciechowksi⁸, N. Turgeon⁹, C. Wolfe¹⁰, V. Stosor¹¹, J. Charette¹¹, A. Cameron³, S. Ottmann³, S. Huprikar¹², D. Segev³

¹Medicine, Johns Hopkins University, Baltimore, MD, ²Surgery, Mount Sinai, New York, NY, ³Surgery, Johns Hopkins University, Baltimore, MD, ⁴Surgery, University of California San Francisco, San Francisco, CA, ⁵Medicine, University of California San Francisco, San Francisco, CA, ⁶Surgery, University of Minnesota, Minneapolis, MN, ⁷Medicine, University of Minnesota, Minneapolis, MN, ⁸Medicine, Mass General Hospital, Boston, MA, ⁹Surgery, Emory University, Atlanta, GA, ¹⁰Medicine, Duke University, Durham, NC, ¹¹Medicine, Northwestern University, Chicago, IL, ¹²Medicine, Mount Sinai, New York, NY

Meeting: 2019 American Transplant Congress

Abstract number: 343

Keywords: Hepatitis, HIV virus, Infection, Liver transplantation

Session Information

Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues (DCD/ECD) II

Session Type: Concurrent Session

Date: Monday, June 3, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 5:42pm-5:54pm

Location: Room 302

*Purpose: HIV+ liver transplant (LT) candidates face higher mortality and lower access to transplant compared to HIV- counterparts. With the US HOPE Act, HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation is being explored as a potential solution.

*Methods: We performed a prospective multicenter study comparing LT outcomes between HIV+ recipients of HIV D+ and HIV- donor (D-) livers. Recipients had to have suppressed HIV RNA and CD4>100 cells. The HOPE Act allowed for D+ with any CD4 or HIV RNA and donors with false-positive (FP) HIV tests.

*Results: From 3/2016-10/2018, there were 35 LTs at 8 centers: 16 HIV D+/R+, 19 HIV D-/R+ (10 with FP donors). Recipients were similar except for MELD at transplant: median(IQR) 24(18-32), 13(7-21), and 18.5(16-21) for D-, FP, and D+, respectively(p=.03, Table1). No HIV breakthroughs occurred. Opportunistic infections were rare(2 in D-/R+, 1 in D+/R+ Table2). There were 3 deaths among HIV D+/R+; causes were pneumonia, day 7; graft failure, day 30; pulmonary hypertension, 4.6 months, none directly attributed to donor HIV status. Survival shown in Fig1A. Rejection was uncommon (16%, D-/R+; 6% D+/R+, Fig1B).

*Conclusions: In this series, HIV+ recipients were transplanted at a lower MELD with HIV D+ and FP donor organs, demonstrating that continued efforts under the HOPE Act might improve access to LT for a vulnerable population. This cohort, while the first series and largest reported worldwide, remains relatively small and continued surveillance of outcomes is critical.

To cite this abstract in AMA style:

Durand C, Florman S, Bowring M, Brown D, Haydel B, Hamilton J, Stock P, Price J, Pruett T, Kirchner V, Wojciechowksi D, Turgeon N, Wolfe C, Stosor V, Charette J, Cameron A, Ottmann S, Huprikar S, Segev D. HOPE in Action: A Multicenter Prospective Study of HIV to HIV Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/hope-in-action-a-multicenter-prospective-study-of-hiv-to-hiv-liver-transplantation/. Accessed November 22, 2024.

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